My son who is 28 years old has been an insulin dependent diabetic since the age of seven. He is now finding it difficult to do his injections without ...

Question

My son who is 28-years-old has been an insulin-dependent diabetic since the age of seven.

He is now finding it difficult to do his injections without hitting a vein, either in his legs/arms/stomach.

I have been following the progress of inhaled insulin, but seem to have lost track of where it is.

Can you tell me if there are any clinical trials being carried out in England, and if so how do people get to take part?

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I am a practice manager in a GP surgery, but have not seen any information in any of the journals we receive.

Answer

Inhaled insulin is being developed by Sanofi Aventis and Pfizer under the brand name Exubera and several trials have been carried out over the last few years.

Research has now reached the stage that Exubera was submitted to the regulatory authorities in Europe in 2004.

A positive opinion was given in October 2005, which means it is anticipated that Exubera will be approved and brought to market sometime in 2006.

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However, Exubera is a short-acting insulin. This means that it will not remove the need for injections entirely, as people with insulin dependent diabetes will still need to use injections for their long-acting insulin.

Exubera will be licensed for adults over 18 years only and there may still be some concerns about the long-term effects of delivering insulin to the lungs. Further trials may still be needed.

I'm not aware of any clinical trials being conducted at the moment on inhaled insulin, although I would very much recommend you contact Diabetes UK.

They will certainly know about any trials being conducted either here or abroad.

It is possible for insulin-dependent diabetics to run out of injection sites, as it were, if the same sites have been used over and over.

But adjusting his technique to use finer needles and injecting them obliquely through the subcutaneous fat rather than straight down should solve his problems.

The tiniest needle should avoid all but the very tiniest of veins, and even then he would be very unlucky in experiencing any bleeding in more than 1 out 30 occasions.

Most promising research is being focused on transplantation of pancreatic islet cells, but of course these at the current time involve using immuno-suppressant treatment to avoid the risk of tissue rejection.

Encourage your son to return to the local specialist diabetic clinic for further advice on his injection problem,

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